Credentialing Representative

Position Title:            Credentialing Representative
Open Positions:        1
Posted Date:              08/07/2025
Location:                    Remote
Department:               CD Network
Supervisor:                Michael Starks
 
 
Apply online at: https://geha.wd5.myworkdayjobs.com/GEHACareers/job/Lees-Summit-MO/Credentialing-Representative_R-005104-1
 
 
Summary
Administers the credentialing process via vendor network. Develops and creates reports for monitoring and tracking internal network processes and staff production in Salesforce. Works independently to coordinate, develop, monitor and maintain the credentialing process under the supervision of the Supervisor, Credentialing.
 
Duties

• Performs reviews of provider applications. Determines eligibility by applying GEHA’s credentialing criteria and submits completed files to the Peer Review Committee and supervisor for approval and participation in the network.
• Attends Peer Review Committee and provides reports regarding provider application information.
• Analyzes and resolves provider file issues, tracks progress on vendor network management, and produces reports.
• Reviews and analyzes provider file changes.
• Responds to provider inquiries received by letter, phone, or from internal departments.
• Administers re-credentialing of network providers.
• Reviews and monitors provider complaint and grievance files.
• Assists supervisor with denied provider and quality assurance processes.
• Assists other team members as needed to maintain departmental TAT.
• Other duties as assigned.

• BS degree, additional years of analytic experience may be considered in lieu of education.

• Requires three - six years of experience in managed care or health insurance administration, business administration, sales/marketing, or account management.
• Requires effective verbal and written communication skills to communicate with providers and GEHA management staff.
• Candidates must reside in KC metro area.